Article

Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass.

The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Clinical Journal of the American Society of Nephrology (Impact Factor: 5.07). 09/2010; 5(9):1552-7. DOI: 10.2215/CJN.02040310
Source: PubMed

ABSTRACT Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). Serum creatinine (SCr), the current standard, is an inadequate marker for AKI since a delay occurs before SCr rises. Biomarkers that are sensitive and rapidly measurable could allow early intervention and improve patient outcomes. We investigated the value of serum cystatin C as an early biomarker for AKI after pediatric CPB.
We analyzed data from 374 prospectively enrolled children undergoing CPB. Serum samples were obtained before and at 2, 12, and 24 hours after CPB. Cystatin C was quantified by nephelometry. The primary outcome was AKI, defined as a > or =50% increase in SCr. Secondary outcomes included severity and duration of AKI, hospital length of stay, and mortality. A multivariable stepwise logistic regression analysis was used to assess predictors of AKI.
One hundred nineteen patients (32%) developed AKI using SCr criteria. Serum cystatin C concentrations were significantly increased in AKI patients at 12 hours after CPB (P < 0.0001) and remained elevated at 24 hours (P < 0.0001). Maximal sensitivity and specificity for prediction of AKI occurred at a 12-hour cystatin C cut-off of 1.16 mg/L. The 12-hour cystatin C strongly correlated with severity and duration of AKI as well as length of hospital stay. In multivariable analysis, 12-hour cystatin C remained a powerful independent predictor of AKI.
Serum cystatin C is an early predictive biomarker for AKI and its clinical outcomes after pediatric CPB.

0 Bookmarks
 · 
158 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute renal injury increases risk of death after cardiac surgery. The objective of the study was to evaluate the ability of the pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria to characterize the development of postoperative renal damage in children after cardiopulmonary bypass (CPB) and to evaluate the relationship between the severity of kidney injury and mortality, pediatric intensive care unit (PICU) length of stay, and the duration of mechanical ventilation (MV). In this retrospective study including children undergoing CPB surgery during a 3-year period in the PICU of a tertiary hospital, demographic, clinical, surgery-related, and postoperative clinical data were collected. Kidney damage was assessed with pRIFLE criteria. Four hundred and nine patients were included. Early acute kidney injury (AKI) was found in 82 patients (achieving categories Risk 44; Injury 16; Failure 22). Early AKI was associated with younger age (P = 0.010), longer CPB, deep hypothermic circulatory arrest (DHCA) use, ICU stay >12 days, MV >4 days, and death (P < 0.001). Controlling the effect of age, CPB, DHCA use, previous cardiac surgeries, and Risk Adjustment in Congenital Heart Surgery Surgical Severity Score (RACHS-1), early AKI development proved to predict ICU stay >12 days [odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.9-6.5, P < 0.001)] and need of MV >4 days (OR 5.1; 95 % CI 2.6-10.2, P < 0.001). Early AKI when evaluated with the pRIFLE criteria can predict prolonged ICU stay, need of prolonged MV, and mortality.
    Pediatric Nephrology 02/2014; · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the past 10 years, great effort has been made to define and classify a common syndrome previously known as acute renal failure and now renamed "acute kidney injury (AKI)." Initially suggested and validated in adult populations, AKI classification was adapted to the pediatric population and recently has been modified for the neonatal population. Several studies have been performed in adults and older children using this consensus definition, leading to improvement in the knowledge of AKI incidence and epidemiology. In spite of these advances, the peculiar renal pathophysiology of critically ill newborn patients makes it difficult to interpret urine output (UO) and serum creatinine (SCr) levels in these patients to diagnose AKI. Also, new urine biomarkers have emerged as a possible alternative to diagnose early AKI in the neonatal population. In this review, we describe recent advances in neonatal AKI epidemiology, discuss difficulties in diagnosing AKI in newborns, and show recent advances in new AKI biomarkers and possible long-term consequences after AKI episode.
    BioMed research international. 01/2014; 2014:601568.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:The aim was to determine which biomarker of renal injury (KIM-1 or cystatin C) is more sensitive and whether erythropoietin protects kidneys injured by perinatal asphyxia.Methods:Animals were designated in 3 groups: AE - the pups that survived perinatal asphyxia and subsequently received 2.5 µg (0.1ml) of darbepoetin-alfa intraperitoneally; A - the pups that survived perinatal asphyxia and received 0.1ml 0.9% NaCl; C - control group. The pups were sacrificed in the different ages of life (6h, 24h, 48h, 7 days and 14 days of age - 10 rats in each subgroup). Immunohistopathological evaluation of kidneys was performed.Results:At 48h, day 7 and day 14, absolute injury scores were significantly lower in group AE as measured by both biomarkers. Cystatin C expression was the most intensive 6h upon hypoxic event (average value of absolute injury score was 2.82) and declined over the time. Expression of KIM-1 was less intensive, average value of absolute injury score at 6h was 2.02, and 2.105 at 24h, with the peak value 48h after hypoxic event (2.155).Conclusions:Erythropoietin has a protective effect on hypoxic kidneys. Cystatin C is more sensitive early biomarker of acute kidney injury in comparaton with KIM-1.Pediatric Research (2014); doi:10.1038/pr.2014.50.
    Pediatric Research 04/2014; · 2.84 Impact Factor